Fatores determinantes do near miss materno em uma unidade de terapia intensiva obstétrica

OBJETIVO:Avaliar os fatores determinantes da morbimortalidade em unidade de terapia intensiva obstétrica de um hospital universitário.MÉTODOS:Estudo observacional de corte transversal com 492 gestantes ou puérperas. Foram selecionadas pacientes internadas na unidade de terapia intensiva obstétrica no período de um ano, sendo informadas sobre as propostas do estudo e realizada aplicação do questionário. A análise foi feita através do Microsoft Excel 2013 e GraphPad Prism 6. Foram empregados testes do χ2 para verificar associação entre os fatores de risco para morbimortalidade materna grave.RESULTADOS: Foram encontrados como riscos relativos significativamente elevados para desenvolvimento de near missquando comparada à morbidade materna grave, a raça não branca (OR=2,5; RP=2,3); pacientes casadas (OR=7,9; RP=7,1), escolaridade até 2º grau incompleto (OR=3,1; RP=2,8), procedente do interior (OR=4,6; RP=4,0), renda familiar menor que 1 salário mínimo (OR=7,0; RP=5,5), distúrbios hipertensivos gestacionais (OR=16,3; RP=13,2), realização do pré-natal (OR=5,0; RP=4,2) e a via de parto cesárea (OR=39,2; RP=31,2).CONCLUSÕES: Questões socioeconômicas, clínicas e assistenciais mostraram-se relacionados à prevalência de near miss, revelando a importância de intervenções amplas para melhorar esses indicadores. Reforça-se a importância da realização de pré-natal para identificação de riscos potenciais, garantia de um suporte nutricional à gestante, tratamento de doenças e estabelecimento de programa de imunização materna, assim como uma melhor assistência no que tange aos aspectos clínicos das pacientes, objetivando diminuir o risco obstétrico e neonatal.

Near-Threshold Computing

Valmistustekniikoiden kehittyessä IC-piireille saadaan mahtumaan yhä enemmän transistoreja. Monimutkaisemmat piirit mahdollistavat suurempien laskutoimitusmäärien suorittamisen aikayksikössä. Piirien aktiivisuuden lisääntyessä myös niiden energiankulutus lisääntyy, ja tämä puolestaan lisää piirin lämmöntuotantoa. Liiallinen lämpö rajoittaa piirien toimintaa. Tämän takia tarvitaan tekniikoita, joilla piirien energiankulutusta saadaan pienennettyä. Uudeksi tutkimuskohteeksi ovat tulleet pienet laitteet, jotka seuraavat esimerkiksi ihmiskehon toimintaa, rakennuksia tai siltoja. Tällaisten laitteiden on oltava energiankulutukseltaan pieniä, jotta ne voivat toimia pitkiä aikoja ilman akkujen lataamista. Near-Threshold Computing on tekniikka, jolla pyritään pienentämään integroitujen piirien energiankulutusta. Periaatteena on käyttää piireillä pienempää käyttöjännitettä kuin piirivalmistaja on niille alunperin suunnitellut. Tämä hidastaa ja haittaa piirin toimintaa. Jos kuitenkin laitteen toiminnassa pystyään hyväksymään huonompi laskentateho ja pienentynyt toimintavarmuus, voidaan saavuttaa säästöä energiankulutuksessa. Tässä diplomityössä tarkastellaan Near-Threshold Computing -tekniikkaa eri näkökulmista: aluksi perustuen kirjallisuudesta löytyviin aikaisempiin tutkimuksiin, ja myöhemmin tutkimalla Near-Threshold Computing -tekniikan soveltamista kahden tapaustutkimuksen kautta. Tapaustutkimuksissa tarkastellaan FO4-invertteriä sekä 6T SRAM -solua piirisimulaatioiden avulla. Näiden komponenttien käyttäytymisen Near-Threshold Computing –jännitteillä voidaan tulkita antavan kattavan kuvan suuresta osasta tavanomaisen IC-piirin pinta-alaa ja energiankulusta. Tapaustutkimuksissa käytetään 130 nm teknologiaa, ja niissä mallinnetaan todellisia piirivalmistusprosessin tuotteita ajamalla useita Monte Carlo -simulaatioita. Tämä valmistuskustannuksiltaan huokea teknologia yhdistettynä Near-Threshold Computing -tekniikkaan mahdollistaa matalan energiankulutuksen piirien valmistaminen järkevään hintaan. Tämän diplomityön tulokset näyttävät, että Near-Threshold Computing pienentää piirien energiankulutusta merkittävästi. Toisaalta, piirien nopeus heikkenee, ja yleisesti käytetty 6T SRAM -muistisolu muuttuu epäluotettavaksi. Pidemmät polut logiikkapiireissä sekä transistorien kasvattaminen muistisoluissa osoitetaan tehokkaiksi vastatoimiksi Near- Threshold Computing -tekniikan huonoja puolia vastaan. Tulokset antavat perusteita matalan energiankulutuksen IC-piirien suunnittelussa sille, kannattaako käyttää normaalia käyttöjännitettä, vai laskea sitä, jolloin piirin hidastuminen ja epävarmempi käyttäytyminen pitää ottaa huomioon.

Normal median near nerve potential

In routine studies of sensory nerve conduction, only fibers e7 µm in diameter are analyzed. The late components which originate from thinner fibers are not detected. This explains why a normal sensory action potential (SAP) may be recorded in patients with peripheral neuropathies and sensory loss. In the present study we investigated the late component of the median SAP with a near nerve needle electrode technique in 14 normal volunteers (7 men and 7 women), aged 34.5 ± 14.8 years. The stimulus consisted of rectangular pulses of 0.2-ms duration at a frequency of 1 Hz with an intensity at least 6 times greater than the threshold value for the main component. Five hundred to 2000 sweep averagings were performed. The duration of analysis was 40 or 50 ms and the wave analysis frequency was 200 (-6 dB/oct) to 3000 Hz (-12 dB/oct). We used an apparatus with a two-channel amplifier system, 200 MW or more of entry impedance and a noise level of 0.7 µVrms or less. The main component mean amplitude, conduction velocity and latency and the late component mean amplitude, conduction velocity and latency were respectively (mean ± SD): 26.5 ± 5.42 µV, 56.8 ± 5.42 m/s, 3.01 ± 0.31 ms, 0.12 ± 0.04 µV, 16.4 ± 2.95 m/s and 10.6 ± 2.48 ms. More sophisticated equipment has an internal noise of 0.6 µVrms. These data demonstrate that the technique can now be employed to study thin fiber neuropathies, like in leprosy, using commercial electromyographs, even in non-academic practices

Atherogenic lipid profile of Brazilian near-term newborns

Cardiovascular disease is the primary cause of death in Brazil. Recent studies have shown that low birth weight and preterm birth are linked to a higher prevalence of cardiovascular disease. The aim of the present study was to compare the levels of lipids and apolipoproteins and atherogenic indexes between term and near-term newborn infants. A sample of umbilical cord blood was obtained from 135 newborns (66 males) divided into two groups: 25 near-term neonates (35-36.6 weeks of gestational age) and 110 term neonates (37-42 weeks of gestational age). The total cholesterol concentrations were higher in the near-term neonates than in the term group (94.04 ± 8.02 vs 70.42 ± 1.63 mg/dl, P < 0.01), due to an increase in the LDL-cholesterol fraction in the near-term group (57.76 ± 6.39 vs 34.38 ± 1.29 mg/dl, P < 0.001). The atherogenic indexes (total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol and apolipoprotein B/apolipoprotein A-I) were higher in the near-term group (P < 0.001, P < 0.001, and P < 0.05, respectively). The gestational age of the newborns was inversely correlated with total cholesterol and LDL-cholesterol, and also with the total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol indexes. These findings demonstrate that the lipid profile is worse in the group of near-term neonates compared with the term group. Future studies are needed to determine if this atherogenic profile in near-term neonates can affect body metabolism, increasing the risk for cardiovascular diseases in adult life.

High pressure near infrared study of the mutated light-harvesting complex LH2

The pressure sensitivities of the near infrared spectra of the light-harvesting (LH2) complex and a mutant complex with a simplified BChl-B850 binding pocket were compared. In the mutant an abrupt change in the spectral properties occurred at 250 MPa, which was not observed with the native sample. Increased disorder due to collapse of the chromophore pocket is suggested.

A new & accurate map of the North Pole with all the countries hitherto discovered situated near or adjacent to it as well as some others more remote. Drawn from the latest and best authorities and regulated by astronom.l observat.ns by Eman. Bowen.

0-meridiaani: Lontoo. - Koordinaattiasteikko: N90°-55°[50°].

Comparison of baseline data between chronic kidney disease patients starting hemodialysis who live near and far from the dialysis center

Introduction: The treatment offered to chronic kidney disease (CKD) patients before starting hemodialysis (HD) impacts prognosis. Objective: We seek differences among incident HD patients according to the distance between home and the dialysis center. Methods: We included 179 CKD patients undergoing HD. Patients were stratified in two groups: "living near the dialysis center" (patients whose hometown was in cities up to 100 km from the dialysis center) or as "living far from the dialysis center" (patients whose hometown was more than 100 km from the dialysis center). Socioeconomic status, laboratory results, awareness of CKD before starting HD, consultation with nephrologist before the first HD session, and type of vascular access when starting HD were compared between the two groups. Comparisons of continuous and categorical variables were performed using Student's t-test and the Chi-square test, respectively. Results: Ninety (50.3%) patients were classified as "living near the dialysis center" and 89 (49.7%) as "living far from the dialysis center". Patients living near the dialysis center were more likely to know about their condition of CKD than those living far from the dialysis center, respectively 46.6% versus 28.0% (p = 0.015). Although without statistical significance, patients living near the dialysis center had more frequent previous consultation with nephrologists (55.5% versus 42.6%; p = 0.116) and first HD by fistula (30.0% versus 19.1%; p = 0.128) than those living far from the dialysis center. Conclusion: There are potential advantages of CKD awareness, referral to nephrologists and starting HD through fistula among patients living near the dialysis center.

The near ultraviolet absorption spectrum of phosgene /

The near ultraviolet absorption of phosgene has been assigned to a * 1 1 ~.--n, A;-- Al electronic transition from vapour phase spectra recorded under conditions of high resolution and low_t~mperature. Progressions in Vi, v2' V3' V4 and V4 ha\1e been identified in the spectrum and have been analyzed in terms of vibronic transitions between a planar ground and a nonplanar excited state. A ba~rier height of 3170 cm~l:and a nona planar equilibrium angle of 32.5 were calculated for the upper state from a fit of the energy levels of a Lorentzian-guadratic potential func- ~ion to the observed levels of V 4 . ' ~he false ori- 3in, 41 0 , of the spectrum has been assigned to the band at 33,631 cm -1 . An oscillator strength of -3 1 . 1 f = 1. a x 10 has been obtained for the A - A 2 1 transition.

Regional variations of deformation mechanisms in the Lorrain Quartzite near Whitefish Falls, Ontario, Canada /

The quartzite microfabric found in the Lorrain Formation was studied across the La Cloche syncline, along a regional north-south transect along highway 6, near Whitefish Falls, Ontario. The complete stratigraphic sequence across the syncline is preserved, and is present on each fold limb. The lithostratigraphic units with the smallest grains size and lowest mica content are located close to the core of the fold, while coarser grained mica and feldspar rich units are situated at the northern and southern most extent of the transect. Deformation mechanisms vary with lithology and with position across the fold. Pressure solution appears to be the dominant deformation mechanism in the feldspathic, micaceous and ferruginous units. In the finer grained, mica poor white medium grained and cherty sandstone units, grain boundary migration (GBM) characteristics show dominance over those of pressure solution and show high amounts of fracturing which cut migrated boundaries and therefore post date GBM. All samples across the fold display a preferred orientation of quartz c-axes. The senses of asymmetry of fabrics are found to be similar across the syncline, with the exception of the ferruginous sandstone unit. Formation of these similar fabrics synmietries can not be the result of strain related to first order folding. The mica content appears to be related to the percentage of quartz lost due to pressure solution as a result of strain; the more mica present, the less quartz was lost. Calculations based on the shape of initial grains suggest that conservatively 30% of the quartz volume has been dissolved out of the Lorrain quartzite, and potentially migrated hundreds of meters to other members of the Huronian Supergroup as there was no meso or macroscopic evidence observed in outcrop.

The satellite band patterns in the near ultraviolet absorption spectra of isotopic compounds of acetaldehyde

The 3700 A - 3000 A absorption spectra of CH3CHO and its isotopic compounds such as CH3CDO, CD3CHO and CD3CDO were studied in the gas phase at room temperature and low temperatures. The low resolution spectra of the compounds were recorded by a 1.5 m Baush and Lomb grating spectrograph. The high resolution spectra were recorded by a Ebert spectrograph with the Echelle grating and the holographic grating separately. The multiple reflection cells were used to achieve the long path length. The pressure-path length used for the absorption spectrum of CH 3CHO was up to 100 mm Hg )( 91 . 43mo The emission spectrum and the excitation spectrum of CH3CHO were also recorded in this research. The calculated satellite band patterns \vhich were ob-tailied by the method of Lewis were used to compare with the observed near UV absorption spectrum of acetaldehyde. These calculated satellite band patterns belonged to two cases: namely, the barriers-in-phase case and the barriers- out-of-phase case. Each of the calculated patterns corresponded to a stable conformation of acetaldehyde in the excited state . The comparisons showed that the patterns in the observed absorption spectra corresponded to the H-H eclipsed conformations of acetaldehyde in the excited state . The least squares fitting analysis showed that the barrier heights in the excited state were higher than in the ground state. Finally, the isotopic shifts for the isotopic compounds of acetaldehyde were compared to the compounds with the similar deuterium substitution.

Landscape geochemical investigations in the vicinity of a lead deposit near Snertingdal, southern Norway

Landscape geochemical investigations were conducted upon portions of a natural uniform landscape in southern Norway. This consisted of sampling both soil profile samples and spruce tree twigs for the analysis of twelve chemical elements. These elements were cobalt, copper, nickel, lead, zinc, manganese, magnesium, iron, calcium, sodium, potassium and aluminum which were determined by atomic absorption analysis on standardized extraction techniques for both organic and inorganic materials. Two "landscape traverses" were chosen for a comparative study of the effects of varying landscape parameters upon the trace element distribution patterns throughout the landscape traverses. The object of this study was to test this method of investigation and the concept of an ideal uniform landscape under Norwegian conditions. A "control traverse" was established to represent uniform landscape conditions typical of the study area and was used to determine "normal" or average trace element distribution patterns. A "signal traverse" was selected nearby over an area of lead mineralization where the depth to bedrock is very small. The signal traverse provided an area of similar landscape conditions to those of the control traverse with significant differences in the bedrock configuration and composition. This study was also to determine the effect of the bedrock mineralization upon the distribution patterns of the twelve chemical elements within the major components of the two landscape traverses (i.e. soil profiles and tree branches). The lead distribution within the soils of the signal traverse showed localized accumulations of lead within the overburden with maximum values occurring within the organic A horizon of soil profile #10. Above average concentrations of lead were common within the signal traverse, however, the other elements studied were not significantly different from those averages determined throughout the soils of the control traverse. The spruce twig samples did not have corresponding accumulations of lead near the soil lead anomaly. This is attributable to the very localized nature of the lead dispersion pattern within the soils. This approach to the study of the geochemistry of a natural landscape was effective in establishing: a) average or "normal" trace element distribution patterns b) local variations in the landscape morphology and c) the effect of unusually high lead concentrations upon the geochemistry of the landscape (i.e. within the soil profiles and tree branches). This type of study provides the basis for further more intensive studies and serves only as a first approximation of the behaviour of elements within a natural landscape.

Some ecological factors affecting the input and population level of total and faecal coliforms and salmonella in Twelve Mile Creek, Lake Ontario and sewage waters near St. Catharines, Ontario

Some Ecological Factors Affecting the Input and Population Levels of Total and Faecal Coliforms and Salmonella in Twelve Mile Creek, Lake Ontario and Sewage Waters Near St. Catharines, Ontario. Supervisor: Dr. M. Helder. The present study was undertaken to investigate the role of some ecological factors on sewage-Dorne bacteria in waters near St. Catharines, Ontario. Total and faecal coliform levels and the presence of Salmonella were monitored for a period of a year along with determination of temperature, pH, dissolved oxygen, total dissolved solids, nitrate N, total phosphate P and ammonium N. Bacteriological tests for coliform analysis were done according to APHA Standard Methods by the membrane filtration technique. The grab sampling technique was employed for all sampling. Four sample sites were chosen in the Port Dalhousie beach area to determine what bacteriological or physical relationship the sites had to each other. The sample sites chosen were the sewage inflow to and the effluent from the St. Catharines (Port Dalhousie) Pollution Control Plant, Twelve Mile Creek below the sewage outfall and Lake Ontario at the Lakeside Park beach. The sewage outfall was located in Twelve Mile Creek, approximately 80 meters from the creek junction with the beach and piers on Lake Ontario. Twelve Mile Creek normally carried a large volume of water from the WeIland Canal which was diverted through the DeCew Generating Station located on the Niagara Escarpment. An additional sample site, which was thought to be free of industrial wastes, was chosen at Twenty Mile Creek, also in the Niagara Region of Ontarioo 3 There were marked variations in bacterial numbers at each site and between each site, but trends to lower_numbers were noted from the sewage inflow to Lake Ontario. Better correlations were noted between total and faecal coliform population levels and total phosphate P and ammonium N in Twenty Mile Creek. Other correlations were observed for other sample stations, however, these results also appeared to be random in nature. Salmonella isolations occurred more frequently during the winter and spring months when water temperatures were minimal at all sample stations except the sewage inflow. The frequency of Salmonella isolations appeared to be related to increased levels of total and faecal coli forms in the sewage effluent. However, no clear relationships were established in the other sample stations. Due to the presence of Salmonella and high levels of total and faecal coliform indicator organisms, the sanitary quality of Lake Ontario and Twelve Mile Creek at the sample sites seemed to be impaired over the major portion of the study period.

Three people on the lawn near Memorial Hall, Chapman College, Orange, California

Three people are sitting on the lawn near Memorial Hall, Chapman College, Orange, California.